Pennsylvania Small Business
Health Insurance Plans 2022

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PA Small Business Health Insurance Plans

Pennsylvania Small Business Health Insurance Plans

Pennsylvania Small Business Health Insurance Plans 2022. The following is an overview of the rules that govern small group health insurance plans in the State of Pennsylvania.

The information that is discussed below includes the laws that have been mandated by the Affordable Care Act (ACA or "Obamacare"), as well as the laws that are required by Pennsylvania State government.

If you own and operate a PA small business and you already offer small group health insurance or you're thinking about offering small group health insurance - this guide can help you better understand the regulations, requirements and available Pennsylvania small business health insurance plans available.

Learn how to get Pennsylvania small business health insurance plans for 1 to 50 employees. The best small business health insurance providers in PA offer affordable rates, flexible coverage options and access to a large network of medical providers.

Below are some answers to commonly asked PA small business health insurance plan questions:


How Much Does Pennsylvania Small Business Health Insurance Cost?

The average price of a standard Pennsylvania small business health insurance policy ranges from around $583 to over $1706 per employee per month based on; single or family, location, coverages offered, deductibles and more.

What Are The Small Business Health Insurance Regulations In Pennsylvania?

Pennsylvania Small Business Health Insurance Plans

Pennsylvania imposes more health insurance regulations than most states. As such, it is very important for small business owners to be aware of these regulations so that they can make the right decisions for themselves and their employees.

Some of the most notable Pennsylvania health insurance laws are those that specifically pertain to the policies. One such law is that when a policy reaches the end of its term, the insured always has the option to renew for another term, which is referred to as a "guaranteed renewability" provision.

Additionally, medical conditions that have been diagnosed or treated within 5 years before a policy's effective date does not have to be covered by the health insurance company; however, this exclusion cannot last for any longer than 12 months, though for most health insurance companies, the exclusion period is shorter.

In addition to the above, all small businesses are eligible to purchase Pennsylvania small business health insurance plans. Additionally, employers that employ more than 2 but fewer than 50 employees must be offered the same health insurance policies that all other Montana small businesses are offered.

It is important to note, however, that it is legal for health insurance companies to mandate minimum enrollment requirements. If a health insurance company imposes this requirement, a certain percentage of employees must purchase the policy, otherwise the policy can be terminated.

Furthermore, health insurance companies are allowed to require employers to pay a certain amount of their employees' premiums.

According to PA Department of Human Services, The Affordable Care Act (ACA) has dramatically changed the health care landscape in Pennsylvania and primarily affected people who do not have health care or who have limited health care coverage.

Does Pennsylvania Participate In The Affordable Care Act?

Affordable Care Act Pennsylvania

In 2010, the Affordable Care Act (ACA or "ObamaCare") was passed by the United States Congress and was signed into law by Obama. Following its passage, provisions of the law have continued to be phased in, and as of January 1, 2014, the majority of American citizens and legal residents of the United States are required, by law, to have qualifying health care coverage.

If they fail to have coverage, they are responsible for paying an annual tax penalty for each month they aren't insured, which is known as the "individual mandate".

The cost of the penalty for failure to have qualifying coverage is $95 per adult and $47.50 per child, or 1% of your total taxable income; whichever amount is higher - as much as $285 per family. In 2017, the penalty increased, and has continued to increase thereafter.

Qualifying Exemptions For The Individual Mandate

Individuals who meet one of the following are exempt from the individual mandate and the associated tax penalties in PA:

  • Illegal aliens
  • Jailed individuals
  • Religious objections
  • The cost of health insurance coverage is higher than 8% of your household income
  • Those who aren't covered for less than three months during the calendar year
  • Those who have hardship waivers
  • Your income level is blow the 100% poverty level

What Are The Affordable Care Act Requirements For Pennsylvania Small Businesses?

Pennsylvania Small Business Health Insurance Plans Claim Form

If you're a small business owner in Pennsylvania, you must provide your employees with insurance. This is a requirement that was put into place by the Affordable Care Act.

Referred to as the Employer Shared Responsibility provision, all employers must offer their employees at least one of the ACA-compliant Pennsylvania small business health insurance plans, otherwise then can face fines of up to $2,000 per employee.

Pennsylvania small business owners can purchase coverage for their employees through the state's Small Health Option Program (SHOP) exchange, or from a private insurance agent or broker.

Affordable Care Act Standardized Essential Health Benefits

As per the ACA, all qualifying health insurance plans must offer 10 standardized essential benefits.

Depending on the state, additional benefits may also be required. The 10 ACA standardized essential benefits are as follows:

  1. Ambulatory patient services (medical care that is offered without being admitted to a hospital)
  2. Emergency services
  3. Hospitalizations, such as overnight stays and surgical procedures
  4. Lab services
  5. Mental health and substance abuse disorder services, including behavioral health treatments, such as psychotherapy and counseling
  6. Pediatric health care services, including vision and oral care; however, adult vision and dental coverage aren't essential health benefits under ACA
  7. Pregnancy, maternity, and newborn care, including before and after birth
  8. Prescription pharmaceuticals
  9. Preventative and wellness services, as well as management for chronic diseases
  10. Rehabilitative and habilitative services and devices, including services and devices for injuries, disabilities, and chronic health conditions

Additional Health Benefits Mandated In Pennsylvania

Not only do health insurance policies in Pennsylvania have to include the benefits mandated by the Affordable Care Act, but they must also contain the additional benefits that the state government has mandated. These additional benefits include the following:

  • Chemotherapy infusion therapy
  • Diabetes care management supplies and education
  • Durable medical equipment - scalp prosthesis
  • Reconstruction surgery following mastectomy

Standardized Pennsylvania Small Business Health Insurance Plans
ACA Metal Levels

In order to make it easier to compare costs and benefits, the Affordable Care Act has designated all qualifying Pennsylvania small business health insurance plans to be one of four metal colors, including Bronze, Silver, Gold, and Platinum.

Each of these designations is based on the average amount of health care costs that the plan will cover, which is illustrates at percentages of how much the insurance company will cover for health care, as well as the amount the insured will have to pay out-of-pocket.

All insurance companies that are participating in the federal or state health care exchange program must offer at least the Silver and Gold Pennsylvania small business health insurance plans.

All four of the metal plans have a shared maximum out-of-pocked amount that the insured can be charged during any calendar year. The following table illustrates this information:

Metal Plan Insurer Pays / Insured Pays
Bronze60% / 40%
Silver70% / 30%
Gold80% / 20%
Platinum90% / 10%


Guaranteed Issue

As per the ACA, individuals cannot be denied coverage or charged higher premiums because of their past health history, or their gender.

Additionally, look-back and waiting periods cannot be imposed. Additionally, policies are effective when they are issued and all coverage is renewable if the individual chooses to renew the policy.

However, plans can be canceled if the individual fails to pay their premiums or commits fraud.

How Are PA Health Insurance Premiums Determined?

A premium is the amount the insured must pay out-of-pocket in order to maintain their health insurance policy. The premiums that are charged for any of the qualifying metal plans can be based on the following:

  • Age of the individual
  • Whether or not the individual uses tobacco
  • Where the individual lives, based on a rating area
  • The number of family members who will be enrolling

What Types Of Health Insurance Plans Are Available For Pennsylvania Small Businesses?

Health Insurance Plan Types

While there are several types of health insurance plans to choose from, the following plans are the most popular among PA small business owners:

Health Maintenance Organization - Simply known as an "HMO", this type of plan offers a variety of health-related services via a network of health care providers and hospitals that exclusively contract with the HMO, or who agree to offer their services to members of the HMO. Employees who participate in this type of plan usually have to choose a primary care physician (PCP), and receive most of their care from this physician. If a specialist is needed, the PCP will recommend one that is affiliated with the HMO.

Preferred Provider Organization - More commonly referred to simply as "PPO", this type of health insurance plan is the most common among Pennsylvania small business owners. The insurance company provides a preferred list of health care providers, and employees must receive their medical care from the doctors and hospitals on that list for their claims to be paid at the highest level possible - but they also have the flexibility to see any other provider anywhere in or out of state.

Point-of-Service Plan - Known as a (POS), this type of health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Members can access care from in-network or out-of-network providers and facilities, but coverage is better when you stay in-network. POS plans may vary, but generally, plans are considered a blend of HMO and PPO plans - offering more flexibility than HMOs, but less than PPOs.

Health Savings Account - A health savings account (HSA) is a special type of bank account that allows participants in the insurance plan to save money that can be used specifically for the medical care they require in the future. HSA-qualified health insurance plans are usually PPO plans that are specifically designed to be used with an HSA.

Indemnity Health Insurance - This type of health insurance plan allows members to control their own health care and to visit any doctor or hospital they choose. The insurance company would then pay a pre-determined percentage of the total charges for the services that were rendered. Employees may have to pay for some types of services up-front and then they can submit a request for reimbursement with the insurance company.

Pennsylvania Small Business Health Insurance Plans - The Bottom Line

We strongly advise business owners to speak with a CPA and a PA health insurance broker before jumping in and getting any type of the Pennsylvania small business health insurance plans available.

Make sure that you know exactly what each option can do for your company and the potential drawbacks associated with it.

Pennsylvania Economic Business Outlook & Commercial Insurance Requirements

While you might have a fantastic idea for a business, if you aren't setting up shop in the right PA location, there's a good chance that you won't see the success that you hope to achieve. With that said, it's important that you have an understanding of the economic status of the state that you are thinking about doing business in. It's also important for you to know what type of rules and regulations regarding insurance are in place in that state.

Made In Pennsylvania

If you are thinking about doing business in the Commonwealth of Pennsylvania, keep on reading to find out some valuable information that you can use to make the best choices for your operation.

Pennsylvania's Economy Now And Into The Future

In terms of the economy, Pennsylvania's future looks pretty bright. It boasts the sixth largest economy in the United States. It is also home to some of the largest private and public organizations in the nation, as per sales.

The job market is expected to see steady growth in Pennsylvania during the 2022 calendar year. That rate is expected to be 1 percent, which is a marked increase from previous years. This is largely due to the high pool of educated laborers that reside in the state. Currently the unemployment rate is 4.9 percent, which is on-par with the rest of the nation. It is believed that the unemployment rate will continue to drop as more jobs are added.

For business owners, there are several industries that will afford success. The food products industry, particularly related to agriculture, contributes largely to the state's economy. This is expected to continue moving forward throughout the 2022 calendar year. Other industries that are forecasted to see growth include:

  • Education
  • Healthcare
  • Manufacturing
  • Mining
  • Printing & Publishing

If you are thinking about doing business in PA, working in one of these industries will likely afford you success.

Insurance Requirements For Businesses In Pennsylvania

The Pennsylvania Insurance Department regulates insurance in PA. Business owners are legally required to carry workers compensation insurance. This type of coverage is a must for any business that employs any W2 part-time or full-time employees, and for employees that are either hourly or salaried. You must also carry PA commercial auto insurance if you plan on using a vehicle to conduct anything related to your business.

While commercial liability insurance is not required in Pennsylvania, it is still a wise idea to invest in. This type of coverage will protect you from the cost of any lawsuits that could potentially arise.

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Also find PA local small businesses by General Liability Class Code and learn about Pennsylvania small business insurance requirements for general liability, business property, commercial auto & workers compensation including PA business insurance costs. Call us (267) 296-1099.

Small Business Health Insurance Plans By State

You can find more state specific small business health insurance information including requirments and coverage by clicking on the state below:


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